Asthma is the most common chronic disease of childhood. It affects approximately 5 million children per year, one fourth of which are less than five years old. Despite increased knowledge of asthma pathogenesis as well as wide availability of specific therapeutic agents and guidelines for their use, asthma morbidity and mortality is increasing. Pediatric asthma is disproportionately high among minorities and low-income populations and recent asthma trends indicate that asthma prevalence is growing fastest among children under 6 years of age. Most pediatric asthma interventions, however, have been targeted towards school-aged children. Upon entering elementary school, children may have chronic histories of poor asthma management and high asthma morbidity. Studies have documented diminished lung function in children with persistent wheezing by age 6 and suggest that early intervention in pre-school children is warranted. The purpose of this proposal is to develop a pediatric asthma management model for children enrolled in the Head Start program using evidence- based asthma management paradigms. Head Start is a nationwide child development program serving 822,316 low-income children and their families. We hypothesize that a multi-faceted, asthma case management model implemented by Head Start personnel will significantly reduce school absences and acute care utilization for asthma, and will improve asthma management practices of children, parents, and staff. We will: 1) Conduct a randomized study of the effectiveness of a multi- faceted, case management intervention implemented by Head Start personnel compared to a minimal intervention group; 2) Identify and describe the factors associated with poor asthma management in a population of children enrolled in Head Start; and 3) Determine the cost of the multi-faceted intervention. The study will be conducted over a three- year period at 29 local Head Start programs with an enrollment of approximately 1000 children. Findings from the study will be used to implement a national model of case management for pediatric asthma in pre-school children.